Evaluation of long-term aggressive dietary management of chronic renal failure in children

Abstract

Ten children with chronic renal failure (CRF) were managed for 3 years using a strict low-protein and low-phosphorus diet supplemented by a mixture of the keto and amino forms of the essential amino acids and histidine (phase II). All of these children were previously managed for at least 2 years with a less rigorous diet of limited protein intake with no specific reduction of phosphorus (phase I). Energy, vitamin D, bicarbonate, phosphate binders and vitamin and mineral mixtures were added as required during both dietary phases. Data on dietary intake showed a significant fall in protein and phosphorus intake and a rise in calcium intake during phase II compared with phase I. Plasma calcium increased and phosphate fell, with an associated fall in intact parathyroid hormone levels. There was a marked improvement in urea creatinine ratios, which suggested an improved anabolic state. Cholesterol and triglyceride levels were improved. Height and weight velocity were increased, becoming significant after 3 years of phase II. Renal function deteriorated at a slower rate than predicted. The diet was well tolerated by the children, with fitness and school performance showing improvement. We conclude that long-term strict dietary management of children with CRF is feasible. Our data suggest an overall improvement in general health and an apparent reduction in the rate of deterioration of renal function.

Changes in leukocyte subsets: clinical implications for children with chronic renal failure

“…The CRF group was recruited from CRF patients that are seen regularly by a multi-disciplinary team who manages their care. The clinical and nutritional management strategies used in this clinic have been published previously [15] and growth and developmental outcomes meet best-practice expectations. Underlying causes of renal failure were dysplasia/reflux nephropathy (n=12), hemolytic uremic syndrome/cortical necrosis (n=5), genetic renal disease (n=3), and glomerulonephritis (n=1).…”

Discussion points

“…These adaptive responses persist even after more than a year of LPD therapy. Further evidence that LPD is safe in CRF patients is provided by the findings that serum proteins, arthropometrics and nitrogen balance remain normal during long-term therapy [31][32][33][34][35][36].…”

Intracellular cytokines in peripheral blood leucocytes in children with chronic renal failure

“…Children with progressive renal failure but not yet on dialysis and an age-matched control group (n=18, median age 14 [range [5][6][7][8][9][10][11][12][13][14][15][16][17] years, 11 male, 7 female; n=24, median age 9 [range 4-17] years, 15 male, 9 female, respectively) were enrolled in the study. Informed consent was obtained prior to blood collection from all children and/or parents.…”

“…The CRF group was recruited from CRF patients who are seen regularly by a multidisciplinary team that manages their care. The clinical and nutritional management strategies used in this clinic have been published previously [8], and growth and developmental outcomes meet best practice expectations. Underlying causes of renal failure were dysplasia / reflux nephropathy (n=11), haemolytic uraemic syndrome /cortical necrosis (n=4), genetic renal disease (n=2) and glomerulonephritis (n=1).…”